Provider Demographics
NPI:1629209184
Name:SIVAK, WESLEY
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:SIVAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-788-6010
Mailing Address - Fax:
Practice Address - Street 1:285 E STATE ST STE 600
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4329
Practice Address - Country:US
Practice Address - Phone:614-566-9496
Practice Address - Fax:614-566-8668
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1346112086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery